Hair transplantation is an accepted technique of restoring hairs on bald scalp in pattern baldness, by different techniques such as follicular unit transplantation, follicular unit extraction (FUE), etc. Transplantation of body hair in to scalp has been suggested as an option to treat extensive cases of baldness with poor donor scalp. However, evidence about its long-term efficacy is yet lacking, with very few published reports and the routine use of the technique is still controversial. Satisfactory outcome can be seen in cases of extensive baldness in whom hairs from different donor areas such as beard, chest, abdomen, arms, thighs were transplanted on to scalp.

BACKGROUND

Hair loss occurs in more than 60% of men and in approximately 10% of women. Balding is a major concern for many, and surgery to treat hair loss (that is, hair restoration) is the most common cosmetic surgery procedure performed on men today. Yet, the market for hair transplantation is dwarfed by the immense market for products that treat hair loss without surgery. These products, which include shampoos, hair-care cosmetics, scalp massagers, laser combs, and many more, have no proven efficacy except for their ability to temporarily increase the volume of existing hair, resulting in a denser appearance than before. Exceptions are the two medications FDA approved: minoxidil and finasteride, which have limited but definite benefit. Interest in hair transplantation will probably increase as knowledge that most modern hair-transplantation techniques can create virtually undetectable restoration spreads. To this day, hair transplantation remains the treatment of choice for most patients with hair loss. Follicular unit transplant is a widely used surgical treatment for androgenic alopecia. However, for patients with extensive hair loss (Norwood 5 and above), scalp donor hair are not sufficient to cover all areas of baldness. Follicular unit extraction makes it possible to extract the individual follicular units from the body and beard donor areas without strip excision and suturing. This enables the use of robust body and beard hair as additional donor hair in suitable patients. The body and beard donor hair differ in characteristics, (length, calibre, colour, growth cycles etc.), from the scalp donor hair.

BODY HAIR AS DONOR HAIR

Body hair transplantation is a procedure designed to restore hair most commonly to the chest and abdomen area, but can also be applied to the pubic hair, axilla, and any other area hair is desired, to both thicken the existing hair or to provide hair growth where there is none. The absence of hair could be due to genetics, prior electrolysis, laser hair removal, or even surgery scar repair, burns or other types of accidents. Some patients seek to have restored only a thin amount of coverage or filling-in of a limited area (i.e. central chest or pubic triangle), while others desire a thick chest and central abdomen area. For some of these cases where maximum density is desired, a second procedure may be necessary.

APPLICATIONS OF BODY HAIR TRANSPLANTS

In general, the preferred Donor Area for hair transplantation is the scalp. However in some cases, other areas of the body, such as the beard, may be used as a source of transplantable hair follicles to accomplish certain hair restoration goals. Beard hair and other sources of body hair are harvested most commonly using the minimally invasive FUE technique. The most common applications of Body Hair or Beard Hair Transplant harvesting is donor scar camouflage, and replenishing a depleted donor area.

1. Linear scar camouflage – Instead of harvesting hair follicles from the scalp, beard hair follicles can be obtained and transplanted into a scar for camouflage or repair purposes.

2. Crown/vertex density – If Scalp Donor Hair is in short supply, beard hair can be harvested and transplanted into the crown or vertex area.

3. Donor Area Replenishment – As hair styles change, patients who have had a significant amount of hair transplants may eventually desire more density in their donor area. Beard or Body Hair Transplantation can ‘recharge’ a donor area by adding follicles into a Donor Area weakened by previous hair transplant procedures.

HOW TO HARVEST BODY HAIR FOR

TRANSPLANTATION
Because the low density of beard hair and other body hair found on the chest, back or abdomen (belly) is low, a linear or strip harvest–while possible–is not typically recommended. Most commonly, the delicate microsurgical harvesting of Body Hair of the beard, chest or other zone is performed with the less invasive FUE approach which leaves no linear scar to hide.
After local anesthesia is applied, the follicles are harvested. Unlike scalp hair follicles which are typically found in groupings averaging 2.4 follicles/follicular unit or graft, body hair groupings contain significantly fewer follicles per follicular unit. For example, beard follicles are typically found in groups of one or two follicles only, whereas scalp hair follicles are found in mostly groups of two and three.
This means that for every graft and for every similarly-sized procedure much less hair is harvested and implanted when performing body hair transplantation.

PRESHAVING PROTOCOL FOR BODY HAIR

TRANSPLANT
The use of body donor hair for transplanting to the bald scalp is termed body hair transplant. In recent times, robust body hair has been used as an adjunct to scalp donor hair to augment the donor hair supply. A large percentage of body hair are in telogen and, as single hair units. Hairs are shaved flush with the skin, three to four days prior to extraction. Preshaving the body donor areas is a simple non-invasive method of isolating the hair in anagen phase.

DISCUSSION:

Body hair transplantation is a relatively new surgical technique used for hair restoration. The scientific basis for the procedure is provided by the concept of recipient influence, which suggests that dermis in the recipient area may exert influence on the growth pattern of transplanted hair and hence when body hair is transplanted on to scalp, it would grow longer, thicker. The rationale has been confirmed in a few published reports. Further, since the procedure is performed by extraction method which produces very small scars, and body is a cosmetically less significant area, body hairs can help to provide an alternative source of donor hair in selected patients. This is particularly so in Indian patients, who do not expose body in public as sunbathing so common in the west, is not popular in Indians.

However, the technique has limitations and the concerns that are yet to be addressed fully:

The procedure is possible only in patients who possess good body hair.

Routine methods of anaesthesia such as infiltration and blocks are not useful and hence the procedure can be painful.

Only the FUE method is suitable for harvesting body hair. This makes the procedure slow and painstaking.

The procedure is slow and needs high degree of motivation for the patient

Body hairs are usually found as 1 and 2 hair units, and hence the density and thereby results achieved may not be as impressive as with scalp hair.

Body hairs are shorter in length, are thinner and hence their extraction needs special technique and expertise. On an average the roots were located at a depth of only 3–4 mm. Transection rates therefore are higher.

Lastly, strong evidence for the procedure is lacking; published reports are few and represent isolated case reports only. Hence the procedure should be performed only in selected patients, in those who are well motivated, and after proper counselling and consent.
The length of hairs after transplantation of body hair is a matter of debate, though it is thought that hairs grow longer on scalp. Analysis of data showed that chest hair is the best of the different body hairs. It has best density, least transection, highest yield and longest growth after transplantation. The back, abdomen and arms cannot be considered as suitable hairs.

SUMMARY

Body hair can be an alternative source in highly selected patients, with poor donor scalp and good body hair. Chest hair is possibly the best among the different body sources, but even this chest hair growth and yield is moderate. Proper counseling is essential before performing the surgery. The method needs to be established properly with more data to define its role and hence the author strongly feels that the current trend of publicizing it on internet websites is unjustified and should be discouraged.